Prevention and Management of Aggression Training and Violent Incidents on U.K. Acute Psychiatric Wards

Abstract

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Physical Restraints in an Italian Psychiatric Ward: Clinical Reasons and Staff Organization Problems

“…Considering the ethical issues and clinical consequences of physical restraint, many studies have recently indicated strategies aimed at reducing the use of this procedure (Barton, 2009;Downes, Healy, Page, Bryant, & Isbister 2009;Hellerstein, Staub, & Lequesne, 2007;Paterson & Duxbury, 2007;Prinsen & Van Delden, 2009;Sclafani et al, 2008). Staff debate and investigation about physical restraints alone can contribute to reducing the use of this procedure in accordance with many authors who evidenced that assault behavior of patients decreased at the same time professionals' awareness of their own feelings toward aggressive patients increased (Bowers et al, 2006;Forster, Cavness, & Phelps, 1999;Stratmann, Vinson, Magee, & Hardin, 1997). More numerous and well-trained staff (Kontio et al, 2009) and more attention by level-of-care staff were cited as the most important strategies for reducing the use of seclusion and restraints (Wynn, 2003).…”

Incidence and risk factors of workplace violence on psychiatric staff

“…Other studies have found much lower percentages of staff members trained in some aspect of workplace aggression prevention [30]. In a narrative review of the effectiveness of aggression management training programs on aggressive incidents, six studies showed that staff training programs may increase levels of aggression [31–36]…”

A narrative review of the effectiveness of aggression management training programs for psychiatric hospital staff

“…Sixteen studies were identified, which examined the effect of aggression management training on aggressive incidents. Six studies (37.5%) provided supportive evidence that staff training programs may reduce levels of aggression (Flannery et al, 1998;Goodykoontz & Herrick, 1990;Mortimer, 1995;Phillips & Rudestam, 1995;Sullivan et al, 2005;Walters & Kay, 2004), four studies (25.0%) provided mixed results (Martin, 1995;Needham et al, 2004;Nijman, Merckelbach, Allertz, & Campo, 1997;Whittington & Wykes, 1996), and six studies (37.5%) reported negative or nonsignificant results (Bowers et al, 2006;Carmel & Hunter, 1990;Helmuth, 1994;McCue, Urcuyo, Lilu, Tobias, & Chambers, 2004;Meehan, Fjeldsoe, Stedman, & Duraiappah, 2006;Smoot & Gonzales, 1995). The supportive research includes the only randomized control trial to evaluate the effectiveness of staff training for reducing aggression (Phillips & Rudestam, 1995).…”

“…It appears that aggression management training may also trigger negative outcomes, such as increases in aggressive incidents during the training period (Meehan et al, 2006), as well as short-term increases in physically aggressive incidents (Bowers et al, 2006) and patient-tostaff assaults (McCue et al, 2004). Factors that have been suggested to contribute to these negative outcomes include systemic problems in the local service context (i.e., staff shortages), the inability of training to reduce levels of aggression below a certain point (i.e., a floor effect), staff feeling more confident and being more likely to confront patients after training, an organization's total reliance on staff training to reduce aggression, increased reporting behavior by staff of aggressive incidents following training, and an insufficient "critical mass" of staff members who have received training (Bowers et al, 2006;Carmel & Hunter, 1990;Meehan et al, 2006).…”